Do you have allergies? Are you sensitive to certain foods or chemicals?  If so, you are part of an epidemic explosion in the incidence of allergies and sensitivities in the U.S. and Western societies. The allergy epidemic is frequently blamed on the profusion of pollutants and toxic man-made chemicals in modern industrial society.  And the conventional medical approach to dealing with allergies is to avoid exposure to allergens, and to block allergic reactions by using antihistamines.

But there is an alternative explanation and a more effective treatment, consistent with the theory of hormesis.  The explanation is called the hygiene hypothesis and the treatment is called allergen immunotherapy.  I’ll discuss these both shortly, but first let’s look at what is really behind the outbreak of allergies in the modern world.

The allergy explosion. In his book “Why Things Bite Back: Technology and the Revenge of Unintended Consequences“, Edward Tenner noted that hay fever was virtually unknown in the year 1800.  But by the end of the nineteenth century, hay fever and other allergies had become widespread.  Yet, according to Tenner, this did not seem to be a consequence of industrialization or urbanization per se:

In fact, as hay fever and other allergies multiplied in the nineteenth century, it was not working class children growing up amid industrial haze but instead the scions of the best households that were affected. Epidemiologists are beginning to believe that large families, messy play, and early infections could have helped condition children’s immune systems not to gear up against a common substance like pollen when they first encountered it.  The protein that mediates hay fever, IgE, appears designed to defend the body against worm infestation. The allergist and historian Michael Emanuel has speculated that hay fever results from IgE deprived of its original target, noting that “man evolved with his parasites and their may be a price to pay for their removal.” (WTBB, pp. 102-3).

More recently, over the past several decades in the U.S., the prevalence of atopic dermatitis  in children has skyrocketed. A high percentage of these kids go on to develop full-blown allergies and asthma.  And paradoxically, wider use of medication to control allergies does not seem to be helping.  According to a 1996 article in Environmental Health Perspectives, citing Peter Gergen of the National Institite of Allergy and Infectious Disease, we are confronted with a disturbing reality:

Trends in Asthma Prevalence, 1982-1993

[D]uring the last three decades, asthma prevalence and morbidity in the United States has been rising. “The paradox of asthma is that we’ve had good treatment and quite adequate medications, and yet we’re still having this problem,” said Gergen… The increase in asthma is not unique to the United States. Asthma appears to be growing worse in other economically developed countries as well.

But the article follows the conventional way of thinking, going on to put the blame on environmental factors prevalent in urban areas:

Spurred by the alarming statistics, researchers are focusing on direct exposures to allergens indoors where people are spending more of their time. Allergen levels are thought to be higher in less well-ventilated homes, where moisture accumulates, allowing mildew and molds to grow. Research shows that cumulative exposure to dust mites, which live in bedding, upholstery, and carpets, causes some people to develop allergic sensitivity, including asthma and airway hyperresponsiveness. The levels of cockroach antigen generally found in suburban homes are too low to sensitize individuals, but the 10-fold higher levels found in inner-city dwellings are enough to cause sensitization and appear to be associated with asthma. ”We’re also concerned about second-hand tobacco smoke,” said Alfred Munzer, pulmonary specialist at Washington Adventist Hospital and former president of the ALA. “There is increasing evidence that childhood exposure to environmental smoke can be a predisposing factor to developing asthma.”

Yet, in contradiction to the above statement about the effects of cigarette smoke, the incidence in allergies has been rising at the same time as smoking is on the decline. Furthermore, exposure to environmental pollutants and indoor allergens like dust mites cannot explain the increase in food allergies.  In fact the rise of food allergies might give us a partial clue:  According to a recent CNN article, there is evidence that the standard Western diet has altered intestinal flora and weakened our immune systems:

A study in Proceedings of the National Academy of Sciences compared the gut bacteria from 15 children in Florence, Italy, with gut bacteria in 14 children in a rural African village in Burkina Faso. They found that the variety of flora in these two groups was substantially different. The children in the African village live in a community that produces its own food. The study authors say this is closer to how humans ate 10,000 years ago. Their diet is mostly vegetarian. By contrast, the local diet of European children contains more sugar, animal fat and calorie-dense foods. The study authors posit that these factors result in less biodiversity in the organisms found inside the gut of European children. The decrease in richness of gut bacteria in Westerners may have something to do with the rise in allergies in industrialized countries, said Dr. Paolo Lionetti of the department of pediatrics at Meyer Children Hospital at the University of Florence. Sanitation measures and vaccines in the West may have controlled infectious disease, but the decreased exposure to a variety of bacteria may have opened the door to these other ailments.

Even establishment allergists like Dr. Hugh Sampson and Dr. Scott Sicherer of Mt. Sinai Medical Center in New York are unable to explain the dramatic rise in food allergies, and are beginning to doubt the advice given to parents to avoid exposing their children to milk, eggs, peanuts, tree nuts, or seafood at a young age.  According to a recent article in the New Yorker:

For most of his career, he believed, like most allergists, that children are far less likely to become allergic to problematic foods if they are not exposed to them as infants. But now Sampson and other specialists believe that early exposure may actually help prevent food allergies. Dr. Sampson recalls that, in 1980, when he started researching food allergies, as a fellow in immunology at Duke University, “I approached the subject with the assumption that I would prove it didn’t exist,” Sampson said. Sampson watched as the incidence of food allergies rose alarmingly in the West while cases remained rare in Africa and Asia.

The hygiene hypothesis.  Observations such as those above have led to an alternative explanation for the mushrooming of modern allergies. The hygiene hypothesis holds that the upsurge in allergies is caused not by an increased exposure to foreign substances, but rather by too little exposure to these allergens, particularly during childhood!  It holds that microbes are our friends; the bacteria and other microorganisms in our gut, on our skin and throughout our bodies protect us from intruding pathogens and foreign substances.  What is more, early childhood exposure to a variety of novel environmental materials — colloquially known as “dirt” — is essential to stimulating, developing and strengthening the immune system. But the modern transition to a more sterile environment has deprived us of both the natural microbial defense system and a mature and robust immune system. The lack of primary microbial and immune defenses leads the body no choice but to activate its emergency backup system: the allergic response.

While modern hygiene and medicine have provided great benefits by controlling or eliminating deadly infectious pandemics like influenza, the plague, and malaria, we may have gone too far with the concept of hygiene.  The current equation of sterility with cleanness or goodness has become a misguided obsession, robbing us of our primary defenses.

The human immune system is complex, and it is impossible to do an adequate job of fully explaining how it works in a short article like this.  One of the clearest, most accessible accounts of the immune system I’ve seen is in a recent book about the hygiene hypothesis: “Why Dirt Is Good: 5 Ways to Make Germs Your Friends”, by Dr. Mary Ruebush.  Ruebush explains that we actually have two immune systems:  the innate immune system and the adaptive immune system. The innate immune system wards off infection from pathogens in a generic, non-specific way, using cells like phagocytes and lymphocytes to physically engulf and remove the invaders. But it is the adaptive immune system that allows us to respond more selectively to very particular invaders without attacking ourselves or “friendly” substances like foods or benign and familiar substances in our environment.  And it is the adaptive immune system that goes awry with allergies, sensitivities…and other immune disorders such as auto-immune disease.  But how does this happen?

Adaptive immunity. Your adaptive immune systems consists of antibody-carrying B cells (produced in your bone marrow) and T cells of two types (Helper T cells and Killer T cell) from the thymus, a small organ in the middle of your chest.  The thymus is like a “school” in which T cells are “educated” to respond to specific external threats.  There is a critical period of the thymus organ in early childhood, during which the adaptive immune system is “educated”; after this critical period the thymus shrivels down in size and becomes less useful.  By means of exposure to a variety of environmental agents during this critical period of our youth, this adaptive immune system puts together an army of specialized “soldiers”:

• macrophages that roam around as “sentinels” throughout the body to encounter invading antigens;
• neutrophils that serve as “foot soldiers”, bringing distress messages back to the thymus;
• helper T cells in the thymus that can recognize the antigen and rapid multiply themselves, sending out legions of reinforcements;
• killer T cells and B cells, the actual antigen fighters that are directed by the helper T cells.  The B cells go after extracellular antigens, whereas the killer T cells attack body’s own cells that get infected with intracellular antigens (e.g. viruses).

The adaptive immune cells (B and T) cells develop normal responses only if they are stimulated by exposure to foreign substances. Most of the B and T cells remain “uneducated” and have a short lifetime and rapid turnover. Only a very few B and T exposed cells become memory cells with a long life time. Children get primed with IgG antibodies from their mother and IgA antibodies from breast milk which provide “passive” immunity for the first two years of life.  After that, children need to begin activating their own adaptive immunity – their own IgMs and IgGs.

Insufficient exposure means an immature immune system. If this process of educating the adaptive immune system is not sufficiently activated in early childhood, the immune system of the adolescent or adult remains underdeveloped.  Then the response to foreign bodies relies more on the “emergency” system, using IgE antibodies instead of IgG, IgA, or IgM antibodies.

It is these IgE antibodies that tend to overreact, causing allergies. But what is the origin of this strong, misplaced IgE defense? Many immunologists think that the IgE defense most likely originated as a defense against parasites. According to Ruebush,

Parasites are a special problem for your immune system. They are the only category of invader in which the foreigner is actually orders of magnitude larger than anything your immune system has to combat it…Your mast cells hang out just below your mucous surfaces (like in your nose and intestines) and just under the skin. They’re on the lookout for invading parasites…If the mast cells go on the attack against the parasite, they simply explode–they bascially napalm the area. Basophils and eosinophils, the other granulolytic parasite-attacking cells, join in….Allergies are an example of a good immune response gone bad…In developed countries parasitic diseases are no longer common…Overall, this is a good thing…The lack of even a few parasites in your body, however, can be a problem….In the absence of parasites, [the] anti-parasite response can become misdirected against harmless substances in the normal environment. And when your body unleashes an anti-parasite response against something harmless, the damage to your own tissues cause the miserable symptoms of allergies: runny nose, sneezing, hives, diarrhea, and possibly even death by anaphylactic shock.  (WDIG, pp. 79-86)

Essentially, an “under-trained” adaptive immune system, such as that of someone raised in a sterile environment, is more prone to confuse harmless foreign bodies like pollen, dog hair, peanuts, eggs, or insect venom, for parasites. Their IgEs become sensitized towards these allergens, attach themselves to the mast cells on mucous membranes or beneath the skin.  Once the allergen reappears, a full-blown chemical attack, including histamine release, is initiated.

There is a genetic tendency for children of allergic parents to have allergies, but this can be short circuited through breastfeeding. Babies who are breastfed during the first four months have more IgA antibodies, fewer IgE antibodies and a much lower prevalence of allergies.  After breastfeeding, the next most important step is to expose children to a variety of environments, including different foods, flowers, people, animals, and–yes–dirt and “germs”!

So much for scientific explanations. But what can you, as an an adult, actually do if you have problem allergies? Maybe you missed the boat in childhood and didn’t get sufficient exposure to allergens, microbes or — perish the thought — parasites.  But now you are past childhood.  Is there anything you can do to repair the situation, strengthen your primary adaptive immunity, and dampen your “emergency” IgE allergic response?

The answer is: most likely, yes.

Hormetism for allergies.  Readers of this blog have learned about the principle of hormesis, a broadly validated biological principle by which exposure to modest amounts of stress stimulate an organism’s defense and repair processes, resulting in a net increase in the capacity to face increased levels of the original stress.  Hormetism is nothing more than the systematic, practical application of the science of hormesis in order to strengthen your body or mind in one way or another.  Examples of Hormetism discussed on this blog include:

• high intensity interval training for fitness and fat loss
• plus lens therapy to overcome myopia
• cue exposure therapy to moderate appetite and addictions
• cold showers to stimulate thermogenesis for weight loss and overcoming depression
• philosophical Stoicism to replace negative emotions like fear, anger, or frustration with positive emotions like joy and gratitude.

So is there really a way to apply Hormetism to allergies?  The answer is yes and it follows directly from the hygiene hypothesis, which in effect holds that the development of the human system itself is a paramount example of hormesis.

There are two promising approaches that have been scientifically validated.  The first one is quite interesting, but only for the brave.  The second has been applied for close to a century and is undergoing a recent resurgence with an excellent track record of permanently reducing or eliminating allergies.  I’ll start with the more unusual of the two approaches.

Helminthic therapy. This is a nice name for what others have called, more colloquially, “worm therapy”.  It follows directly from the hypothesis that for most of their evolutionary history, humans co-evolved with parasites.  In the modern area, with the virtual elimation of parasites from the Western world, it is this lack of exposure to parasites that has led to an overactive and inappropriate IgE response.

Helminths are nonpathogenic parasites that are deliberately introduced into patients.  There is a body of research suggesting that helminths can be very effective in rebalancing the immune response, moderating the IgE defense, and thereby reducing or eliminating allergies.  I realize this may seem repugnant to some, but the parasites used are microscopic and benign, not the grotesque tapeworms and bizarre organisms seen in medical textbooks. If interested, there is some useful background and references on the Helminthic Therapy website.

Allegen immunotherapy. The conventional medical approach to dealing with allergies is to avoid exposure to allergens (for example by installing air filters and keeping your carpets clean)  and to disable the immune or inflammatory response by medicating with histamines.  As with many applications of Hormetism, allergen immunotherapy takes a diametrically opposite approach. By exposing the patient first to minute amounts of allergen, and progressively increasing the exposure in a systematic manner, the primary adaptive immune system is strengthened. According to Dr. Adrian Morris, the emergency IgE response is dampened by means of stimulating production of an allergen-specific IgG that blocks the IgE response, and possibly also by modulation of the helper T cell response.  In many ways, allergen immunotherapy resembles vaccination, except that object is not to raise antibodies, but rather to normalize an overactive immune response.  Also known as hyposensitization therapy or tolerization, allergen immunotherapy has been found to be very effective:

Allergen specific immunotherapy is the only treatment strategy which treats the underlying cause of the allergic disorder. It is a highly cost-effective treatment strategy which results in an improved quality of life and a reduction in allergic- and allergen-related asthma, as well as a reduction in days off school/work. Immunotherapy has been shown to produce long-term remission of allergic symptoms, reduce severity of associated asthma as well as reduce the chances of new sensitizations to allergens developing… The benefits of allergen specific immunotherapy are long lasting unlike symptomatic based treatments. Immunotherapy is most effective for pollen, dust, and animal dander allergies, and may help those with asthma.

Lest you think that exposure to an allergy-provoking allergen would be dangerous or set off your allergy, read on:

Even the most allergic individual can tolerate minuscule amounts of an allergen without experiencing symptoms. Immunotherapy commences with the subcutaneous injection of a tiny amount of offending allergen, and gradually increases the dose until the individual’s immune system is essentially ‘retrained’ to tolerate exposure without producing an allergic response. This process is also known as specific immunotherapy.

Clinical methods. The most established method of adminstering allergen immunotherapy in the U.S. is to give allergy shots, starting very dilute, and gradually increasing in potency.  There is an emerging approach that appears to be more effective, faster, and has fewer side effects: sublingual immunotherapy, also known as SLIT.  Minute amounts of the allergy provoking substances are formulated in “allergy drops” that are placed under the tongue. While SLIT is practiced widely in Europe, it is still being evaluated by the FDA and is not yet approved in the U.S.

With both allergy shots and subligual therapy, treatment is usually started a few months before the start of allergy season, to build up tolerance. Typically, treatment must be continued for 3-5 years to be fully effective, and may need to be periodically repeated to maintain tolerance.  If interested, you may want to check out several additional references that give a balanced appraisal of allergen immunotherapy, including this 2000 study in the journal Thorax, and this overview in  WiseGeek which suggests that children in particular may benefit from this approach.

Other applications of immunotherapy. In the introduction, I suggested that immunotherapy may also be effective in treating other immunological “overreactions” including chemical and food sensitivities and auto-immune disorders. There is less evidence and research in these areas, and in order to keep this article short, I’ve chosen not to address these possibilities.  But I think it is worthwhile to follow the research in this area.  If the hygiene hypothesis is true, which I think it is, then the possible applications of “exposure” therapies are numerous and offer great promise.

Share your thoughts on this topic on the Discussion Forum.

Other than recommending this book as a great vacation read or a way to rekindle your passion for running, I’d like to concentrate here on one of its central claims about the biomechanics of barefoot running, because it resonates so strongly with the thesis of Hormetism and Edward Tenner’s theories about the “revenge effects” of technology — and because it has implications that extend well beyond the sport of running. McDougall’s seemingly paradoxical assertion is that running without shoes makes one less susceptible to injury than using modern engineered running shoes, with their high-tech cushioning. Says McDougall: “Running shoes may be the most destructive force ever to hit the human foot.” (BTR, p. 168)   …How can this possibly be true?

Perhaps the most controversial thesis of McDougall’s book is that humans evolved to be long distance runners, and that at some point in our evolution as hunters we exploited this ability to actually run down large game such as antelope–animals that could outsprint us for short spurts, but would eventually tire and give up.  McDougall cites some archeological and biometric evidence, but I’m not so sure I buy this, and I’m somewhat skeptical and weary of the constant invocation of evolutionary arguments to explain just about everything related to diet, health and fitness. It’s just that it is so difficult to verify these speculations, so  I happen to prefer more testable explanations based upon physiology. And in the area of physiology, I believe that McDougall is onto something. The idea that adding padding or protection can hurt or injure us seems to be a paradox–at first glance.  But if we can understand why protective armor has this effect, perhaps it can teach us something about human adaptation that extends beyond the domain of running.

Shoes and foot injuries. Among the many experts McDougall cites, Stanford track coach Vin Lananna has a certain credibility when he states: “I can’t prove this, but I believe when my runners train barefoot, they run faster and suffer fewer injuries…We’ve shielded our feet from their natural position by providing more and more support…If you strengthen the foot by going barefoot, I think you reduce the risk of Achilles and knee and plantar fascia problems.” (BTW, p. 169-170).  Dr. Barry Bates, who directs the University of Oregon’s Biomechanical/Sports Medicine lab, gathered data showing that the cushioning on shoes does not reduce impact on the legs, but may actually promote injuries. To gain insight into why this should be so, consider another study reported by McDougall, this time from McGill University, showing that gymnasts landing on a mat instinctively adjust their landings based on the thickness and softness of the mat in order to achieve balance upon landing. The same thing happens when we run with cushioned soles: “your legs and feet instinctively come down hard when they sense something squishy underfoot. When you run in cushioned shoes, your feet are pushing through the soles in search of a hard, stable platform.” (p. 173). These adjustments are part of the proprioceptive or “body awareness” sensory system that is built into our neuro-muscular physiology. The story is otherwise when running barefoot on a hard surface:

To see pronation in action, kick off your shoes and run down the driveway. On a hard surface, your feet will briefly unlearn the habits they picked up in shoes and automatically shift to self-defense mode; you’ll find yourself landing on the outside edge of your foot, then gently rolling from little toe to big until your foot is flat. That’s pronation–just a mild, shock-absorbing twist that allows your arch to compress.  (BTW, p. 176)

And according to Dr. George Hartmann, a physical therapist trainer to long-distance runners, pronation is a actually good thing, not the defect it has been made out to be by many:

Your foot’s centerpiece is the arch, the greatest weight-bearing design ever created. The beauty of any arch is the way it gets stronger under stress; the harder you push down, the tighter its parts mesh. No stonemason worth his trowel would ever stick a support under an arch; push up from underneath, and you weaken the whole structure. Buttressing the foot’s arch from all sides is a high-tensile web of twenty-six bones, thirty-three joints, twelve rubbery tendons, and eighteen muscles, all stretching and flexing like an earthquake-resistant suspension bridge…I’ve worked with over a hundred of the best Kenyan runners, and one thing they have in common is marvelous elasticity in their feet. That comes from never running in shoes until you’re seventeen. (BTW, pp. 176-177).

So the explanation here is clear: Our skeletons, musculature and nervous systems are highly refined and well-coordinated adapative systems which adjust both instanteously and by means of longer term adjustments to in order handle the terrain.  These “proprioceptive” adjustments take place virtually beneath the level of consciousness, through the exquisite feedback systems of our body and brain. Try to circumvent these systems, and the protective mechanisms will weaken, exposing us to injury.

I’ve checked this out, and McDougall doesn’t seem to be cherry-picking the research to support his biomechanical thesis.  My informal survey of other research found additional supporting evidence:

• A study by Harvard’s Daniel Lieberman et. al, in the prestigious journal Nature, entitled “Foot strike patterns and collision forces in habitually barefoot versus shod runners“. The study found that “habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground.”  To see how this works in action, take a look at blogger Karen Given’s interview of Lieberman, who teaches her how to run barefoot and demonstrates how dramatically this reduces the collision forces on her foot and body:
• A review by Warburton in the Australian journal Sportscience, of foot injuries, which found that “Wearers of expensive running shoes that were promoted as correcting pronation or providing more cushioning experienced a greater prevalence of these running-related injuries than wearers of less expensive shoes (Robbins and Gouw, 1991). In another study, expensive athletic shoes accounted for more than twice as many injuries as cheaper shoes, a fact that prompted Robbins and Waked (1997) to suggest that deceptive advertising of athletic footwear (e.g., “cushioning impact”) may represent a public health hazard. Anthony (1987) reported that running shoes should be considered protective devices (from dangerous or painful objects) rather than corrective devices, as their capacity for shock absorption and control of over-pronation is limited. The modern running shoe and footwear generally reduce sensory feedback, apparently without diminishing injury-inducing impact–a process Robbins and Gouw (1991)  described as the “perceptual illusion” of athletic footwear. A resulting false sense of security may contribute to the risk of injury (Robbins and Gouw, 1991).  Yessis (2000, p.122) reasoned that once the natural foot structures are weakened by long-term footwear use, people have to rely on the external support of the footwear, but the support does not match that provided by a well functioning foot.
• Additional studies and commentary, summarized in an article “Should you be running barefoot?” in Runner’s World, by the aptly named Amby Burfoot.  Burfoot’s article has a nice historical overview of great barefoot runners over the past century.
• Barefoot Ken Bob, a somewhat whimsical website devoted to barefoot running as an avocation, which includes research, practical advice, and announcements of upcoming barefoot races.

Finally, here is short video clip that gives a fairly simple explanation of barefoot running technique, featuring aficionado Barefoot Ted, who will be familiar to readers of Born to Run:

This research regarding the adaptive capacity of the foot coheres nicely with the overall thrust of Hormetism, in its confirmation that strengthening of our capabilities proceeds by progressive, periodic exposure to stress, to an appropriate degree and at a rate that allows us to adapt. It may seem paradoxical to some, but the fact remains that our strength is frequently compromised when we resort to crutches or corrective devices in the (misguided) attempt to shield or cushion ourselves from discomforts and shocks.

Technology and paradox. These findings about barefoot running are actually part of a much larger lesson about the paradox of injury, muscular weakening and other adverse consequences that come from an over-reliance on the protective technologies. This larger thesis is in fact the story of a much larger book published originally in 1996 by Edward Tenner: “Why Things Bite Back: Technology and the Revenge of Unintended Consequences“. You might think that a book with that title would be an anti-technology rant. But this book is not that, it is rather an insightful and even amusing look at technology, written by a technophile who does appreciate the benefits of technology, but at the same time was drawn to probe this puzzling downside to our over-reliance on technology. He has pulled together a wide-ranging survey and analysis of what he calls the “revenge effects” of technology, attempting to explain why it is that technologies often backfire in ironic and unexpected ways that tend to undermine their effectiveness. Such a book could go on for volumes if one wanted to catalogue every possible instance of the perverse effects of technology, but Tenner wisely limits his focus to several probing chapters on a handful of especially illuminating fields: medicine, environmental engineering, pest control, the computerized office, and sport. And while he has interesting things to say in all these areas, I would like to pick up specifically on his discussions of sports injuries, which are particularly relevant to generalizing our understanding of the paradox of barefoot running.

Tenner’s discussion covers a wide range of different sports, from high contact sports like boxing, rugby and football, to seemingly benign recreational sports, like running, skiing and tennis.  Football is illustrative of the evolution of a once intensely violent sport. In 1905, a year when there were 23 deaths in intramural collegiate play, President Theodore Roosevelt threatened to ban the sport unless the rules were changed regulating allowable conduct. Later, in 1939, plastic helmets were introduced and after World War II they entirely replaced the thin padded leather helmets used until that point. But this had an unexpected effect:

Where plastic helmets were adopted, players intent on using maximum force to stop an opponent began to use their headgear, with the mouth guard that soon accompanied it, as a battering ram. This intensifying tactic all too often had its own unintended consequence: spinal fracture and paralysis…What seemed to be a technological solution had become an extension of the medical problem…The NCAA banned aggressive use of the helmet in 1976, and injuries dropped…Spearing, the use of a helmet in place of the shoulders to knock down an opponent, is now banned but is still widespread, and not just in professional play.  (WTBB, p. 217)

So protection led to intensification of injury, but this was moderated by additional rule changes. So far, so good. But this reduction in acute injuries was replaced by a more insidious problem, chronic injuries:

While there are fewer catastrophes, most of which result from spearing and other dangerous practices, serious injuries have actually increased with the spread of better protective equipment. From the First World War through the 1950s, only four in ten professional players per season reported injuries that needed surgery or resulted in prolonged absence from the game. By the 1980s, seven in ten were seriously hurt each season, according to a study by the NFL Players Association…The game’s “ballistic” style calls for brief but powerful bursts expressed as joint- and vertebra-jarring collisions far more severe than those of Theodore Roosevelt’s day. The helmets, face shields, mouthpieces, and padding are better than ever, and deaths may be rare, but neither protective nor conditioning technology can prevent damage to the joints. Since massive injections of anti-inflammatory drugs and painkillers make it possible for battered athletes to return to play, the new intensity means trading immediate relief for long-term disability…Knee and hip surgery can extend players careers, but usually only at the price of later pain, inflammation, and repeated rounds of surgery. (WTBB, pp. 218-219)

Football is certainly not unique in this regard.  For example, Tenner makes a similar points about skiing:

The replacement of wood by plastics and composites in the 1950s changed and extended the sport just as dramatically as lifts had done earlier in the century. Gone were the rituals of waxing. And on the way out, it seemed at the time, were the broken bones that once formed part of the folklore of skiing. At first, the new equipment shifted some of the injury from ankle fractures (common with lower prewar boots) to twisting fractures of the tibia. A fall often led to this spiral break of the bone. Then came further improvements. New, rigid plastic boots and bindings employing strong, lightweight alloys were designed to release the legs of skiers at a predetermined level of force…To the extent that skiers are risk seekers, they will respond to safer equipment and more carefully maintained slopes by seeking more dangerous runs and increasing their speed….Protection also leads to greater risk-taking in the slalom event, where skiers voluntarily use protective gear, including helmets, to take a straighter course down the slope…In the days of wooden skiis, the cast-encased leg was a cartoonist’s cliche, but with some reason….ACL sprains now account for up to six injuries a day at large resorts and up to 100,000 annually in the United States. Surgeons can usually repair a torn MCL by stitching ends together: a sprained ACL demands much more difficult techniques, including tendon grafts. (WTBB, p. 224).

The basic message in all of the above is that as protections have increased, injuries have not gone away, but have shifted from the acute to the chronic, and in many cases chronic injuries that are more enduring and difficult to deal with. This message is consistent with the point made on the Rehabilitation page of this blog about the downside of “crutches” such as canes, orthodics, and even eyeglasses.  The difference, in this case, is that these protective aids defeat our intentions in a different context than that of rehabilitation. Instead of impairing our recovery from disability, these protective aids instead make us vulnerable to injury.  (While the distinction between prevention and recovery is important, there is actually the interesting case of Michael Sandler whose RunBare blog documents his story of how he used barefoot running to overcome a serious shattered leg injury, transforming himself from being unable to walk, to running barefoot 80-100 miles per week!)

Protections such as extra support or cushioning no doubt make us safer in certain respects. But while guarding against the strong shocks that can cause acute injury, these very protections can mask the sensory inputs that our body uses to adjust and adapt internally–both in the instant and over time. In doing so, we are making ourselves vulnerable to repetitive stress or other low level chronic injuries that, over time, can become at least as serious, if not more so, than acute injures, because the healing process is not as straightforward.

Lessons. So where does this leave us, and what should we do about it?  Should we always run barefoot and forgo all the protections of padding and modern protective technology when we engage in challenging physical activities like sports? I certainly would not advocate that. But I think the key point here is to be conscious of what we give up by relying on artificial external protections, especially if it means decreasing our reliance on our own internal musculature and nervous system.  We should be wary of getting too far away from contact with our raw senses and physical exertions whenever we pick up a piece of protective athletic equipment, clothing or footwear, and we might consider how to make internal strengthening and perceptual sharpening an essential part of our conditioning when we train and prepare for athletic performance or even to enhance our ability to navigate the ordinary physical challenges of daily life, such as climbing stairs, or lifting groceries or children. In short: beware of “labor saving” devices; the labor you end up saving may actually be have been useful or necessary to your well being!

What do you think?  Please leave your comments below, or visit the Discussion Forum.